Medicalese

I really thought I was doing something when I took medical Spanish for gringos. My ego deserved a pat on the back for learning a new language. In high school, I enrolled in the romantic French class. My intention for attempting another language were good, however, since our Hispanic population continues to boom in our area. Our area is quite diverse – a melting pot, and in all fairness I would also need to learn Chinese, Japanese, Arabic, Portuguese, and Nigerian to name a few of the many languages I’ve encountered. The majority of my patients and their parents make very gracious efforts to help me bridge the communication gap.

There are several other languages that I wish I had been taught in my medical training. Languages in the midst of all the microbiology, pharmacology, pathology and ethics?

The first of these is what I refer to as code speak. Have you noticed that the way physicians document diseases and the insurance coding are legions apart? For instance, a nine month old with wheezing without upper respiratory symptoms. I like the term reactive airway disease because the parents can comprehend it somewhat. There is no ICD-9/ICD-10 code for RAD. In fact, there is no code for mild intermittent asthma or moderate persistent asthma. I really hesitate to assign asthma with haste. Parents really balk at the diagnosis because it’s not usually based on the kind of objective data like lab results or a chest X-ray. In the spirit of evidence based medicine – I have truly tried to incorporate objective data to make that diagnosis. It would be helpful on occasion if there existed a wishy washy code like RAD instead of obstructive pulmonary disease NOS.

Code speak is not limited to pulmonary disease. I have struggles with coding seizures as epilepsy, yeast diaper rash, and newborn codes. There seem to be a million obstetric codes, but a paucity of newborn codes. A code for granulating umbilical stump hanging by a thread would be helpful. A code for overriding sutures would also be helpful since that is a frequent question from parents of my patients.

I suspect that like many of my patients, my coding is still in its infancy. Recently I attempted to educate this infant to find that what coders tell us to code in our offices are still miles apart from what insurance companies will pay for. At the conference I attended, a very knowledgeable coder attempted to navigate us through codes for emergency visits, cerumen extraction, and the combination of sick and well visits at the same time. I am a pretty passionate person about my profession, and I am willing to advocate for better codes and insurance payments. Some days, it just doesn’t seem worth the fight to be paid the $15 for cerumen extraction with bilateral otitis media and nothing else after my nurse and I was wrestled an eighteen month old like the late Steve Irwin handled crocodiles.

Another language that I failed to learn in my training is TV reporter speak. My curiosity is always heightened by the mention that someone is in critical or stable condition. My mind flies to speculate that the woman in critical condition after being spun out on the interstate is ventilated and on a dobutamine drip. Is she being rushed to CT or had heavy output from her chest tube? Is there a published breakdown of what these categories mean? Then again, maybe my medical speculation game during the nightly news is just another way of escaping the realities of the world around us.

Parent speak is another language that seems to have multiple dialects. There are classic examples from residency that include “vomicking” and “thrash”. As the parent of two boys, I felt pretty fluent in parent, but I am still surprised by how filtered my thoughts are by my medical training. Case in point was when friends brought their toddler son to see me in the office. Being a former preemie, he has been susceptible to his fair share of respiratory viruses this past winter. On this particular occasion – I felt he had a right lower lobe pneumonia with crackles at the base. When I mentioned this to his father, Dad’s eyes got wide with anxiety. I cannot tell my wife that he has pneumonia – he tells me. She won’t be able to handle it. With all that they had been through with their former 35 weeker, our agreement was that we would tell mom her son had a “chest infection” leaving the diagnosis as a murky albeit less anxiety provoking than the “p word” That lasted about 5 minutes 15 sec. when mom, a social worker in a nursing home, called to ask me did I mean that her son had pneumonia?

Some days I’m not sure I am even fluent in my native language. How is it that I can tell a parent that their child has x and it comes back that the child has z? Where did I miss the boat? Did I uses too many medical terms, or did I oversimplify?